| Obejective:The risk factors of the elderly patients with PICC catheter related thrombosis were analyzed, in order to improve the knowledge of the elderly patients with PICC catheter related upper extremity deep vein thrombosis and to strengthen awareness of the prevention of thrombosis and reduce the incidence of complications.Methods:The datas of 650 patients who were given PICC catheters were retrospectively analyzed from January 2008 to December 2013 in our hospital. General information, catheter thrombosis cases were collected to establish the database. Application SPSS 20.0 statistical software packages. Statistical methods include:univariate analysis, logistic regression analysis, the statistical results are by P<0.05 was considered significant test level.Result:650 cases were invoved in this study, the occurrence of upper extremity deep vein thrombosis were 233 cases.The rate of thrombosis was 35.8%.The patients aged between 60-102 years, median age 82 years, mean age 81.5±9.3 years,628 cases of male and 22 females, male to female ratio of 28.5:1. Univariate analysis showed that age and BMI of thrombus were significantly higher than the control group.In the group of thrombosis, cancer, DVT history, chronic renal insufficiency, recent surgery, trauma, left arm catheter, PICC tube tip in the innominate vein or subclavian vein were significantly higher.In the control group, the right arm catheter, PICC tube tip in the superior vena cava is higher than the thrombosis group, P<0.05. Multivariate logistic regression analysis showed that age, chronic renal insufficiency and the recent history of surgery were significant difference. These three factors were independent risk factors for elderly patients with PICC catheter related thrombosis.Conclusion:1. Univariate analysis showed that the risk factors in elderly patients with PICC catheter related thrombosis were age, BMI, cancer, DVT history, chronic renal insufficiency, recent surgery, trauma, catheterization arm, catheter tip position.2. Multivariate logistic regression analysis showed that age, chronic renal insufficiency and the recent history of surgery were independent risk factors in elderly patients with PICC catheter related thrombosisObejective:To evaluate the therapeutic effect and the risk factors of antithrombotic therapy in elderly patients with PICC catheter-related upper extremity deep venous thrombosis.Methods:Patients diagnosed as PICC catheter-related upper extremity deep venous thrombosis in our hospital during January 2008 to December 2013 was enrolled in this study. Datas of patients, including general informations, past history of diseases, catheter-related informations, thrombosis-related informations, the ultrasound follow-up results, whether remove the catheter and antithrombotic treatment were recorded and analysed. SPSS20.0 statistical software packages was used. Statistical methods:univariate analysis were performed with chi-square tests and t tests and cumulative thrombus-resolution rate was analysed with Kaplan-Meier analysis. The results were considered statistically significant at P<0.05.Result:A total of 126 patients were enrolled, including 116 males and 10 females, mean age of whom was 86.8±6.3years (69-99 years). There were 49 symptomatic thrombosis patients (38.9%) and 77 asymptomatic thrombosis patients(61.1%). The symptoms of thrombosis including upper limb edema (32 cases), pain (11 cases) and both pain and edema (6 cases). The average time of catheter was of 52.2±72.1 days (7-379 days) when upper extremity deep venous thrombosis was found.100 patients had received antithrombotic treatment after catheter-related upper extremity deep venous thrombosis was diagnosed, the other 26 patients were not treated with antithrombotic therapy. The average time of antithrombotic therapy was 35.4±5.0 days (7-279 days). Thrombosis complete recanalization were seen in 66 cases, partial recanalization in 21 cases, no change in 24 cases and thrombosis progression in 15 cases. According to the effect of antithrombotic therapy, the patients were divided into two groups: recanalization groups and no recanalization groups. The general information of patients in two groups were compared and showed no significant difference (P> 0.05). The catheter-related information of patients in two groups, such as the time of catheter reservation, catheterization arm, whether removal of the catheter, the position of the catheter and whether accept antithrombotic therapy were compared. The results showed that the proportion of the patients who had received antithrombotic therapy and catheter removal was significantly higher in recanalization groups than in no recanalization groups. The proportion of complete recanalization was higher in patients who had remove catheter than those who had not remove catheter(63.7%vs22.9%). Similarly, The proportion of complete recanalization and partial recanalization was higher in patients who had received antithrombotic therapy than those who had not received antithrombotic therapy(62%vsl5.4%,20%vs 3.8%).Kaplan-Meier analysis showed that the cumulative thrombus-resolution rate was significantly higher in patients who had remove catheter and received antithrombotic therapy than in those who had neither remove catheter nor received antithrombotic therapy, P<0.05.Conclusion:1. The effect of antithrombotic therapy in elderly patients with PICC catheter-related upper extremity deep venous thrombosis are related to the removal of the catheter and antithrombotic treatment. Removal of the catheter and antithrombotic treatment are effective in the therapy of thrombosis.2. The patients’age, sex, BMI, complications, the time of catheter reservation, catheterization arm and the position of the thrombosis were not associated with the effect of antithrombotic therapy.3. Removal of the catheter and receiving antithrombotic treatment are equally important for the patients with PICC catheter-related upper extremity deep venous thrombosis.There is an increased risk for recurrence of thrombosis in the new position after the catheter removal, so we suggest that the catheter be reserved for the patients if the symptoms are not serious, catheter is still useful and uninfected. This will help to simplify the management of PICC catheter related upper extremity deep venous thrombosis and provide guidance for clinical work. |
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